April 2012 Imaging Case of the Month

Michael B. Gotway, MD

Associate Editor, Imaging

Clinical History: A 31-year-old previously healthy, immunocompetent, non-smoking female developed cough and was initially treated with broad spectrum antibiotics without improvement. Approximately 48 hours later, the patient presented to her physician with progressive shortness of breath and fever to 103°F. A chest radiograph was performed (Figure 1).

Figure 1: Frontal chest radiograph shows extensive bilateral pulmonary opacities predominantly in the lower lobes with preserved lung volumes, normal mediastinal width, and no definite pleural effusion.

The differential diagnostic considerations for the appearance on the chest radiograph include which of the following?

1. Hydrostatic pulmonary edema
2. Acute hypersensitivity pneumonitis
3. Community-acquired pneumonia
4. Opportunistic pulmonary infection
5. All of the above

Reference as: Gotway MB. April 2012 imaging case of the month. Southwest J Pulm Crit Care 2012;4:102-10. (Click here for a PDF version)

March 2012 Imaging Case of the Month

Michael B. Gotway, MD

Associate Editor, Imaging

Clinical History: A 64-year-old woman presents with weight loss and an intermittent history of cough. Skin tuberculin testing was indeterminate, so a chest radiograph (Figure 1) was performed.

Figure 1:  Frontal (A) and lateral (B) chest radiographs show previous median sternotomy and mild cardiomegaly. Poorly defined, mildly hyperattenuating opacities are present in the apices bilaterally. No evidence of architectural distortion or cavitation is present. A calcified left mediastinal lymph node is present, consistent with prior granulomatous inflammation.

Does this chest radiograph show evidence of current or prior granulomatous infection?

1. True
2. False
3. Unknown

Reference as: Gotway MB. March 2012 imaging case of the month. Southwest J Pulm Crit Care 2012;4:80-7. (Click here for a PDF version of the case)